Medicaid Providers Get Ready for Revalidation

Are you a Medicaid and CHP+ (Child Health Plan Plus) Provider? If yes, do you know as part of the Affordable Care Act (ACA), all existing Medicare and Medicaid providers (including CHP+ providers) must revalidate their enrollment application by March 31, 2016.

The revalidation of the enrollment application is a federal requirement. In order to meet these new Accountable Care Act (ACA) requirements and to ensure that you are enrolled in a new claims processing system, must revalidate their enrollment before March 31, 2016. I don’t have information about other states but State of Colorado is providing the option to their providers to revalidate their enrollment application using their new Online Provider Enrollment (OPE) tool.

As per the law, all existing providers need to revalidate and enroll with the Medicaid. These providers also includes, who are part of Managed Care Organization (MCO), Behavioral Health Options (BHO) and Regional Care Collaborative Organization (RCCO). Revalidation of enrollment is applicable on all those providers, who serves Medicaid and/or CHP+ members, must revalidate, even they do not submit their own claims, and even if they are not currently enrolled directly with Medicaid.

How can a provider revalidate their enrollment?

Keep in mind that the revalidation process will begin on September 15, 2015. The county you are located will dictate when your enrollment window is open.

WARNING

Timely completion of your revalidation is important to Department and the members who are served. In order to comply with federal regulation, the Department may suspend and/or terminate the enrollment of any provider who fails to undergo revalidation.

Please visit your local Medicaid Site for:

  • More instructions
  • Training Opportunities
  • Frequently Asked Questions (FAQs)
  • Revalidation Timeline
  • Information Specific to you provider type

For Colorado, please visit: http://colorado.gov/HCPF/Provider-Resources

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